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In the Donut Hole

Medicare maxes people out

Comments (8)
Tuesday, December 01, 2009

The other day an elderly woman fell into a donut hole right before my eyes. I was standing in line at the drugstore, waiting for a prescription. The customers ahead of me were a diminutive woman leaning precariously on a cane — the quintessential little old lady — and her late-middle-aged daughter. As their purchases were tallied on the cash register, a sudden look of horror came over the desk clerk's face.

"Ma'am," she said, clearing her throat. "Do you have supplemental insurance?"

"What's that?" the old woman said, smiling pleasantly. She was hard of hearing, apparently, and must have thought the clerk was offering some jocular pleasantry.

The clerk repeated her query, this time to the daughter, as if the old lady was a doddering old fool.

"There's something you should know. This medicine costs $170."

"Oh, lord," the daughter responded. "Why is it so expensive?"

"Your mother is in the donut hole," said the clerk, as if this infantile expression was perfectly clear. "She's maxed out. Medicare won't cover this prescription."

A quiet conversation took place as the daughter tried to explain this to her mother.

"Donut hole?" the old woman repeated, baffled by the sudden change of topics to breakfast pastries. "Oh, dear." She snapped her change purse shut, pushed the bagged pills back toward the clerk and announced, "I can't afford my medicine."

The pharmacist, overhearing the exchange, chimed in.

"Here, let me write down the 800-number you can call so that someone can explain this to you."

The mother and daughter blinked and took the slip of paper with the 800-number proffered by the pharmacist. They shuffled away without a word.

Another jolly old soul falls into the donut hole, and another wound is inflicted on the English language. The "donut hole" is a simple way to bypass explaining how the Medicare Part D beneficiary is S.O.L. if the costs of their prescriptions annually exceed $900 (and whose don't?). They must pay out of pocket for all prescriptions up to $4,350, at which point a "catastrophic coverage threshold" is reached and Medicare covers the costs. Though phrases like "donut holes" obscure the "debate" over health care reform, the biggest wound to language has been to refer to any form of government intervention as "socialism." Medicare, then, is socialism, in these people's view. And so is road building, bridge maintenance, public education, state universities, etc.

The "donut hole" shows, of course, that all is not perfect with government-run health initiatives. The chronically ill can fall through the cracks. But if left up to the private sector there would not even be a donut, much less a hole, to fall through. The elderly would just die in their hovels after they ran out of dog food to eat.

The privatization of health care, touted by its fans as more efficient because of the purity of the profit motive, has proven a failure. Paradoxically, the same folks screaming loudest about "socialism" will be first in line for government help when their corporation outsources their jobs to India and they find themselves, like the 86.7 million (or one in three) other Americans under age 65, who've been uninsured in the past two years.

That "privatization of health care" dynamic was on display recently when the government's H1N1 vaccines were scarfed up by Wall Street firms like Goldman Sachs and Citigroup long before even hospitals had them — and ahead of anyone who may have been most at risk. I can think of a lot of terms for that behavior but, I will concede the point: It wasn't "socialism."

 

Comments (8)
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See if you can follow the logic of this article: a couple years ago, the government decided to help the elderly with their drug costs. Medicare would pay 75% of a covered drug up to a limit of $2500 for a total benefit of $1875 (not $900). But if you're really sick, the government will help with catastrophic pharmaceutical costs.

Not a bad deal and in fact, Medicare Part D is one of the few government entitlements whose costs have stayed close to predictions and not broken the national bank. This popular legislation was promoted and then signed into law by a President, but I forget who...and so has Bisbort.

But since nobody should be denied anything ever, it's a great tragedy that the government isn't paying for everything anybody wants. Of course, these costs will never be borne by subpar writers from weekly newpapers, so why not? In fact, why aren't there national limos taking me to see my private doctor while I receive a foot massage?

None dare call it "socialism."
Posted by Eric on 12.1.09 at 17.16
Also, what is the basis for this statement: "The privatization of health care, touted by its fans as more efficient because of the purity of the profit motive, has proven a failure."

Evidence? I guess being liberal means never having to say you're sorry. Or make a case with facts and junk.

Hey, look what I found: "Forty-nine percent (49%) of voters nationwide now rate the U.S. health care system as good or excellent.." Dumb Americans! Don't they know it's a failure?

http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/november_2009/those_who_rate_u_s_health_care_system_good_or_excellent_up_to_49
Posted by Eric on 12.1.09 at 17.25
This comments section is socialism.
Because anybody, regardless of age, race, income level, religion, creed and IQ, is allowed to post here.
Socialism, I tell you.
And it's gotta stop.
Posted by Mel on 12.2.09 at 12.35
"The privatization of health care, touted by its fans as more efficient because of the purity of the profit motive, has proven a failure."

This statement reminds me of the time Bisbort claimed Cash for Clunkers a proven success just days after its implementation.

Good stuff. I always enjoy the ClassWarfareBort Blog.

PS - Mel needs to learn what socialism is and I hope she does. That analogy was rough.
Posted by Joe on 12.3.09 at 8.40
8/5/09
”..Cash for Clunkers program, which has proven to be a resounding success. It's proven, in fact, to be far more successful than anticipated..”

Haha… oh my gosh.

I must echo Eric in saying “being liberal means never having to say you're sorry”… and not having to wait for facts to make absurd statements…. And believing that jobs “saved or created” is a measurable statistic.

Good good stuff as usual.

Posted by Joe on 12.3.09 at 8.55
Was it the type of medication one would die without I wonder?
Posted by old and dying on 12.3.09 at 12.42
"Forty-nine percent (49%) of voters nationwide now rate the U.S. health care system as good or excellent.."
Wow, Eric. That's some great math you got there.
Less than half of the sample gave the health care system a thumb's up. And yet you insist that that means Americans love this health care system.
That's like saying George W. Bush, who lost the 2000 election with less than half of the popular vote, won a landslide victory and thus possessed a mandate to flush America's prosperity down the toilet.
Oh, wait, that is what people said. And that is what happened.
Everyone listen to Eric! He's so brilliant!
And angry!

Posted by Mel on 12.5.09 at 13.23
Great stuff, Mel. My point is that there is NO national crisis where Americans are demanding for massive changes in health care. If you read the news, you'll find that nearly 80% of Americans are happy with their current health care.

Why should I be angry when I have the facts on my side? You're the one intentionally avoiding the facts to fall back on tired old chestnuts. The 2000 election? Yes, yes, very relevant to this debate.

By the way, is it "Mel" or is that short for "Melanie?" In other words, will you be wearing a rented tux or a dress gown to the junior prom?
Posted by Eric on 12.6.09 at 18.41
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